Context: The importance of physiologic distribution of ¹⁸ F-FDG in the spinal cord.Objective: The recognition of the physiologic distribution of ¹⁸ F-FDG in the spinal cord is pivotal for accurate PET/CT imaging interpretation, especially in oncologic patients. Therefore, we performed a systematic review to investigate the normal distribution of ¹⁸ F-FDG throughout the spinal cord.Methods: Data sources: We carried out a comprehensive search of the literature on the physiologic patterns of ¹⁸ F-FDG distribution in the spinal cord. PubMed and Scopus databases were searched using the following keywords: "spinal cord" AND "FDG". Data extraction: Findings of the selected articles were described.Results: Thirteen studies comprising 24,125 patients entered the systematic review. These investigations showed discrepancies in location, size, number, and intensity of ¹⁸ F-FDG uptake throughout the spinal cord. However, cumulative results showed that ¹⁸ F-FDG uptake was higher in the lower thoracic portion of spinal cord (T11-T12). Moreover, a decreasing trend in ¹⁸ F-FDG uptake was observed from cervical to lumbar levels. Low maximal standardized uptake values, female sex, and higher body weight seem to be related to the physiological spinal cord ¹⁸ F-FDG uptake.Conclusions: On ¹⁸ F-FDG PET/CT imaging, focal hypermetabolism of the spinal cord at the level of lower thoracic and lower cervical vertebrae should be considered physiological until proven otherwise.